Hybrid UR Specialist - Authorization & Case Mgmt

New Horizons of the Treasure Coast; United States; Hybrid; USD 55,000 - 75,000; Full time

Job summary

New Horizons of the Treasure Coast seeks a Utilization Review Specialist to manage patient authorization processes, review records in EMR, and secure timely pre-certifications via telephone or provider portal. The role is hybrid, balancing on-site and remote duties within a compliant case management framework.

The ideal candidate will hold a high school diploma, demonstrate strong organizational, verbal, and written communication skills, and may have an associate or bachelor’s degree.

Qualifications

• High School diploma or equivalent required.
• Organizational skills.
• Verbal and written communication skills.
• Associate or Bachelor’s degree preferred.
• Paramedic, EMT or Nursing Assistant certification preferred.

Responsibilities

• Follow each account during the IP stay and on discharge for authorization - document status in the electronic system.
• Escalate any potential disputes or denial of accounts to Director of Revenue or designee
• Trends disputed claims by payor
• Obtain & follow authorization for Case Management Services
• Adhere to federal, state, payer, and local regulations and accreditation requirements impacting case management scope of services
• Adhere to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and agency policies

Skills

Organizational skills

Verbal communication

Written communication

Education

High School diploma or equivalent

Associate degree

Bachelor’s degree

Job description

New Horizons of the Treasure Coast seeks a Utilization Review Specialist to manage patient authorization processes, review records in EMR, and secure timely pre-certifications via telephone or provider portal. The role is hybrid, balancing on-site and remote duties within a compliant case management framework.

The ideal candidate will hold a high school diploma, demonstrate strong organizational, verbal, and written communication skills, and may have an associate or bachelor’s degree.